Expert Opinion: What Killed Anna Nicole Smith?

Dr. Welner, what can we understand from the medical examiner's findings today?

There is no evidence for Anna Nicole Smith ingesting a large amount of pills shortly before her death. This speaks against the likelihood that she intentionally ingested a heavy overdose of pills.

Does this mean that drugs could not have played a role in her death?

No, it does not. In fact, there were earlier reports that she fell in the bathroom shortly before she became unresponsive. If she did fall, intoxication involving Valium (reportedly found in her room) would explain a loss of balance. However, Valium by itself does not kill – it sedates. Over the counter medicines can carry quite sedating effects.

If drugs played a part in Anna Nicole Smith's death, did she necessarily abuse what she took?

Perhaps. But toxicology findings from yet-unfinished analysis of her body fluids will help to distinguish whether there is any higher level of a drug than might be expected. One also has to consider the possibility of the interactions of different drugs on the central nervous system or cardiac rhythm.

How do drug interactions cause death?

Drug interactions may cause death in what may even be modest doses. Sedatives may depress the arousal centers in the brain that drive the heart to beat and lungs to breathe. Medicines may also interact to prolong the impulse of the heartbeat to such a degree that an irregular heartbeat leads to stoppage of the heart altogether.

Dr. Perper mentioned something about inflammation of the heart. Is that an area that might prove to be important?

Yes, it bears watching. For Anna Nicole Smith reported flu-like symptoms in the days preceding her death. An inflammation of the heart or its lining can contribute to an unexpected death, and may follow a sickly presentation. This tragic outcome would have nothing to do with drugs or their interaction.

Folks are wondering why Anna Nicole Smith's child was being cared for by a friend while she was far away. Can you as a forensic psychiatrist explain the significance of this?

Clearly, this is not what you would expect from a mother. Nor would you expect a depressed mother to be traveling away from her daughter. On the other hand, one has to recognize how complex the emotional response to her losing her son some months ago impacted her mood and ability to parent. What we experience as her irresponsibility may reflect a woman who is more irresponsible when depressed and coping (poorly) with stress. A woman with postpartum depression may bond relatively poorly with her child. In addition, there were others around her, including Howard K. Stern, whose advice and involvement in the daughter's care, and in Anna Nicole Smith's separation from the Bahamas, has to be pursued.